Introduction
A Journey into Uncharted Territory
Fifty years ago, a woman who had just tried to kill herself told me something that challenged what I thought I knew about the mind and the brain, and about who we really are.
The forkful of spaghetti was almost to my mouth when the pager on my belt went off, launching the fork out of my hand. I had been concentrating on the emergency psychiatry handbook propped open between my tray and the napkin holder, so the sudden beeping startled me. The fork clattered to my plate, splashing tomato sauce on the open page. I reached down to shut the pager off and noticed a blob of spaghetti sauce on my tie as well. Cursing under my breath, I wiped the blob off and then dabbed at it with a wet napkin, which made it less colorful but a bit larger. Only a few months out of medical school, I was trying desperately to look more professional than I felt.
I walked over to the phone on the cafeteria wall and dialed the number on my pager’s display. There was a patient in the emergency room who had overdosed, and her roommate was waiting to speak with me. I didn’t want to take the time to walk across the parking lot to the on-call room, where I had a change of clothes, so I retrieved the white lab coat from the back of my chair, buttoned it up to hide the stain on my tie, and went down to the ER.
The first thing I did was to read the nurse’s intake note. Holly was a first-year student at the university whose roommate had brought her to the hospital and was waiting for me down the hall in the family lounge. The nurse’s and intern’s notes said Holly was stable but not awake, and that she was sleeping in Exam Room 4 with a “sitter” watching her, a routine precaution for psychiatric patients in the ER. I found her lying on a gurney, wearing a hospital gown, with a tube in her arm and heart monitor leads running from her chest to a portable machine that had been wheeled up next to the gurney. Her tousled red hair splayed across the pillow, framing a pale, angular face with a slender nose and thin lips. Her eyes were closed and she didn’t move when I entered the room. On the gurney shelf under her was a plastic bag with her clothes.
I placed a hand gently on Holly’s forearm and called her name. She didn’t respond. I turned to the sitter, an older African American man reading a magazine in a corner of the exam room, and asked if he’d seen Holly open her eyes or speak. He shook his head. “She’s been out the whole time,” he said.
I leaned closer to Holly to examine her. Her breathing was slow but regular, and there was no odor of alcohol. I assumed she was sleeping off an overdose of some medication. The pulse at her wrist was beating at a normal rate, but skipped a beat every few seconds. I moved her arms to check for stiffness, hoping that might give me a clue as to what drugs she had taken. Her arms were loose and relaxed, and she didn’t wake up when I moved them.
I thanked the sitter and made my way to the family lounge at the far end of the hallway. Unlike the exam rooms, the family lounge had comfortable chairs and a couch. There was a coffee urn, and paper cups, sugar, and creamer on an end table. Holly’s roommate, Susan, was pacing the room when I walked in. She was a tall girl with an athletic build, her brown hair pulled back tightly into a ponytail. I introduced myself and invited her to sit. Her eyes darted around the room, and then she sat down on one end of the couch, fidgeting with the ring on her index finger. I pulled up a chair next to her. The windowless room was not air-conditioned, and I was already starting to sweat in the heat of a late Virginia summer. I moved the standing fan a little closer and unbuttoned my white coat.
“You did the right thing, Susan, by bringing Holly in to the ER,” I started. “Can you tell me what happened this evening?”
“I came home from a late afternoon class,” she said, “and found Holly passed out on her bed. I called out and shook her, but couldn’t wake her up. So I called the dorm counselor and she called the rescue squad to bring her here. I followed in my car.”
Still assuming Holly had overdosed on some medication, I asked, “Do you know what drugs she had taken?”
Susan shook her head. “I didn’t see any pill bottles,” she said, “but I didn’t look around for any.”
“Do you know whether she was taking any medication on a regular basis?”
“Yeah, she was taking an antidepressant that she had gotten from the student health clinic.”
“Are there any other meds in the dorm that she might have taken?”
“I have some medication for my seizures that I keep in the cabinet in the bathroom, but I don’t know that she took any.”
“Did she drink regularly or use other drugs?”
Susan shook her head again. “Not that I’ve seen.”
“Does she have any other medical problems?”
“I don’t think so, but I don’t really know her that well. I didn’t know her before we moved into the dorm a month ago.”
“But she was seeing someone at Student Health for depression? Had she been looking more depressed or anxious lately, or acting strangely?”
Susan shrugged. “We weren’t really that close. I didn’t notice anything wrong.”
“I understand. Do you happen to know about any particular stresses she’s been under lately?”
“As far as I know, she’s been doing well in her classes. I mean, it’s an adjustment for all of us starting college, being away from home for the first time.” Susan hesitated, then added, “But she was having problems with this guy she was dating.” She paused again. “I think he might have been pushing her to do things.”
“Pushing her to do things?”
Susan shrugged. “I don’t know. That’s just the feeling I got.”
I waited for her to continue, but she didn’t.
“You’ve been very helpful, Susan,” I said. “Is there anything else that you think we should know?”
Susan shrugged again. I waited again for her to say something else, but she didn’t. I thought I might have seen a slight shudder.
“How are you doing with all this?” I asked, touching her gently on the arm.
“I’m okay,” she said, too quickly. “But I have to get back to the dorm. I’ve got a paper to write.”
I nodded. “Well, thanks for bringing Holly in and for waiting to talk with me. Why don’t you go back now and get to that paper? You can check on her in the morning if you want. We’ll call you if we think of anything else.”
Susan nodded and stood up, and I walked her to the door. As I reached out to shake her hand, I again caught a glimpse of the stain on my tie and rebuttoned my lab coat so the ER staff wouldn’t notice.
I walked back down the hallway to Holly’s room to see if she’d awakened by then. She was still out cold, and the sitter confirmed that she hadn’t stirred since I’d left. There wasn’t much more for me to do that evening. I spoke with the medical intern evaluating Holly, who said that he was going to admit her to the intensive care unit to monitor her irregular heartbeat. I then called the faculty psychiatrist who was backing me up that night. He agreed there was nothing more for me to do at that point, but told me to make sure I documented everything and that I should check back on Holly and talk with her first thing in the morning. I would have to present her case to the senior psychiatrists on the consultation team on their morning rounds at eight a.m. As I walked across the parking lot to the on-call room, I congratulated myself on not making a fool of myself, and on my good fortune to have the patient admitted to the ICU so the medical intern would be responsible for her admission note and orders that night, rather than me.
When I entered the intensive care unit early the next morning, refreshed with a good night’s sleep and a change of clothes, I scanned the rack at the nursing station for Holly’s medical chart. One of the nurses was writing in it, and looked up at me.
“You’re from Psychiatry?” she asked.
I nodded and said, “I’m Dr. Greyson.” It was not hard to identify me as the shrink, as I was the only one in the ICU wearing street clothes under my white coat, rather than scrubs.
“Holly’s awake now, and you can talk with her, but she’s still pretty drowsy,” the nurse said. “She’s been stable all night except for a few PVCs [premature ventricular contractions].” I knew that those irregular heartbeats could mean nothing, but they could also be related to whatever medications she had taken the night before.
“Thanks,” I said. “I’ll go speak with her briefly now, but the consultation team will be here in about an hour to interview her. Do you think she’ll be stable enough to be transferred to the psychiatry unit today?”
“Oh, yeah,” the nurse said, rolling her eyes. “There are patients stacked up in the ER waiting for a bed here to open up.”
I walked over to Holly’s room and knocked on the jamb of the open door. She now had a tube in her nose as well as in her arm, and the heart monitor leads were now connected to a screen above her bed. I pulled closed the curtain around her bed behind me, and softly called her name. She opened one eye and nodded.
“Holly, I’m Dr. Greyson,” I said. “I’m with the psychiatry team.”
She closed her eye and nodded again. After a few seconds, she mumbled softly, her speech a bit slurred, “I know who you are. I remember you from last night.”
I paused, replaying in my mind our encounter the night before. “You looked like you were asleep in the ER last night,” I said. “I didn’t think you could see me.”
Her eyes still closed, she muttered softly, “Not in my room. I saw you talking with Susan, sitting on the couch.”
That caught me up short. There was no way she could have seen or heard us talking at the far end of the corridor. I wondered whether that wasn’t her first visit to the ER, and whether she could have guessed that I’d talked with Susan there.
“The staff told you that I spoke with Susan last night?” I suggested.
“No,” she said, more clearly now. “I saw you.”
I hesitated, not sure how to proceed. I was supposed to be leading this interview, gathering information about her thoughts of harming herself and what was going on in her life. But I was confused, and didn’t know how to proceed. I wondered whether she was just toying with me, the new intern, trying to rattle me. If so, she was doing a good job. She sensed my uncertainty and opened both eyes, making eye contact for the first time.
Copyright © 2021 by Bruce Greyson
